• Rotational Atherectomy for Underexpanded Undilatable Stents: Is Ablating Away Stent Regret the Best Option?

    Attempting percutaneous coronary intervention of calcified coronary arteries is becoming increasingly common. To ensure success, adequate lesion preparation prior to stent implantation is paramount in order to achieve good final stent expansion. Stent underexpansion is a strong predictor of stent thrombosis and in-stent restenosis. A deployed but underexpanded stent refractory to non-compliant balloon postdilatation is tough to treat. One possibility is stent ablation using rotational artherectomy (RA). This technique was first described by Kobayashi et al. in 2001, in which he described a successful ablation in an underexpanded stent with a heavily calcified “napkin-ring” lesion. Using a deliberate, gentle technique with slow advancement at 150,000 rpm and stepped burr approach (1.5 mm, 1.75, mm and 2.0 mm burr), the operators were able to partially remove stent struts with a superficial layer of calcium plaque that allowed for subsequent balloon dilatation at low pressure. However, safety issues of RA within stents are concerning; these include burr entrapment, coronary dissection, distal embolization and no reflow. However, stent ablation in a porcine model demonstrated at least 95% of pulverized metal particles measured <15 μm on microscopic and radiologic analysis of cardiac tissue, small enough to pass through the coronary microcirculation and ultimately be removed by the reticuloendothelial system.

    Author bio

    Cardiovascular Revascularization Medicine, 2019-11-01, Volume 20, Issue 11, Pages 939-940, Copyright © 2019 Elsevier Inc.

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    Read the full article on Science Direct: Rotational Atherectomy for Underexpanded Undilatable Stents: Is Ablating Away Stent Regret the Best Option?

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